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Surgical Audit and Research

Surgical Audit and Research. Professor Ravi Kant FRCS (England), FRCS (Ireland), FRCS(Edinburgh), FRCS(Glasgow), MS, DNB, FAMS, FACS, FICS, Professor of Surgery. What is Audit ?.

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Surgical Audit and Research

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  1. Surgical Audit and Research Professor Ravi Kant FRCS (England), FRCS (Ireland), FRCS(Edinburgh), FRCS(Glasgow), MS, DNB, FAMS, FACS, FICS, Professor of Surgery

  2. What is Audit ? It is a recording of actual and factual truths and its effects in a particular profession for the further improvement in the practice of that profession.

  3. What is Surgical Audit? It is the systematic critical analysis of the quality of surgical care, including the procedures used , treatment , complications,the use of resources,resulting outcome and the quality of life for the patient, carried out by those personally engaged in the activity concerned .

  4. Audit has been divided: • Medical audit : An audit undertaken by doctors and consists of a review of clinical events. • Clinical audit : A review of all potential medical events surrounding the treatment of a patient. This will include nursing, physiotherapy, social aspects, etc.

  5. Essentially 2 types of audit may be • encountered: • National audit • Local / hospital audit Both are designed to improve the quality of care.

  6. The components of audit • Structure : The physical environment in which healthcare is provided. • Process : The activity of providing care. • Output : The outcome of that care for both the individual and for the community as a whole.

  7. Why do Audit ? 1.Time utilization-cost effectiveness: Surgeon must know how he is spending his time and the resources of the hospital before attempting to improve on time utilization. 2. Mortality/morbidity assessment: In order to investigate the avoidable complications, mortality/morbidity data must be available.

  8. 3.Quality of services-inefficient/misuse : • Assessment of a patient's stay in the hospital might bring to light the misuse or inefficient use of services. • 4. Monitoring performance: • Monitoring the performance of the surgeons is an essential outcome of audit.

  9. 5. Assessment of newer techniques Whether addition of newer surgical techniques has improved health care can be determined. 6. Knowledge of patient satisfaction The patient's view of health care delivery can be assessed. 7. Legal implications In case of accusation of malpractice, audit data can help to establish that the rate of complications compares favorably with that of the accepted standards.

  10. The following steps are essential to establish an audit cycle: Define Re audit Identify analysis Design Analyze & compare Measure

  11. Project design • During the 1st phase , it is very important to keep in mind some important questions. • Why do the study ? • Will it answer a useful question ? • Is it practical ? • Can it be accomplished in the available time and with the available resources ? • What finding are expected ? • What impact will it have ? • Next -- choosing the subject for study .

  12. What is Research ? Clinical researchis a branch of medical science that determines the safety and effectiveness of medications, devices, diagnostic products and treatment regimens intended for human use. These may be used for prevention, relieving symptoms of a disease.

  13. Quantitative vs. Qualitative research

  14. Research vs. Clincal Audit

  15. Scientific Research asks Are we doing the right operation ? Audit Research asks Are we doing the operation right ?

  16. Types of study: Observational Case-control Cross-sectional Longitudinal Experimental Randomized Randomized controlled

  17. 1) Observational study: Evaluating results of condition or treatment in a defined population. Retrospective: analyzing past events Prospective: collecting data contemporaneously.

  18. 2) Case-control study: Series of patients with a particular disease or condition contrasted with matched control patients.

  19. 3) Cross-setional study: Measurements mode on a single occasion, not looking at whole population but selecting small similar group & expanding results.

  20. 4) longitudinal study: Measurements are taken over a period of time, not looking at whole population but selecting small similar group & expanding results.

  21. 5) Expermintal study: Two or more treatments are compared. Allocation to treatment groups is under the control of the researcher. 6) Randomised study: Two randomly allocated treatments.

  22. 7) Randomised controlled study: control group with No treatment. GOLD STANDARD.

  23. Types of study

  24. Sample size Calculating the number of patient required to perform a satisfactory investigation is a very important prerequisite to the study. An incorrect sample size is probably the most frequent reason for research to be invalid. Never forget that more patients will need to be randomized than the final sample size to take into account patients who die, drop out or are lost to follow up.

  25. Types of error: Type I: Benefit is perceived when really there is none (false positive). Type II: Benefit is missed because the study has small numbers (false negative).

  26. The Eliminating bias: Blinded observer: The observers or recorders who do not know which treatment has been used. Single blind: The patient is unaware of the treatment allocation. Double blind: Neither patient nor researcher is aware of which therapy has been used until after study has finished, & these are the best randomized studies.

  27. Confidence Interval “CI” Confidence intervals are used to indicate the reliability of an estimate. Depends on p value.

  28. P value: The probability that results (difference between groups) of this magnitude would be observed if the null hypothesis is true . The lower the p-value the more strongly you can reject the hypothesis .

  29. If p value is small (<5%) probability of obtaining observed difference by chance alone is low – HOrejected. • If p value is large it is conceivable that data are consistent with HO ,which cannot be rejected.

  30. Evidence based surgery: Surgical practice has been considered an art, ask 50 surgeon how to manage a patient and one will get 50 different answers . is a move to find the best ways of managing patients using clinical evidence from collected studies.

  31. Levels of evidence: Evidence grade I: (High)The described effect is plausible, precisely quantified and not vulnerable to bias. Evidence grade II: (Intermediate) the described effect is plausible but is not quantified precisely or may be vulnerable to bias.

  32. Evidence grade III: (Low): concerns about plausibility or vulnerability to bias severely limit the value of the effect being described and quantified.

  33. The Cochrane Collaboration: An international not-for-profit and independent organization, of over 27,000 contributors from more than 100 countries . It produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. The Cochrane Collaboration was founded in 1993 and named after the British epidemiologist, Archie Cochrane.

  34. Refrances Short practice of surgery (baily & love’s) 26th edition. EBM presentation by Prof.Ravi Kant www.nbt.nhs.uk www.wikipedia.com For EBS : www.clinicalevidence.com www.cochrane.org www.nice.org.uk

  35. THANK YOU …

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